One-Third of Adults With Type 2 Diabetes May Have Undetected, Symptomless Cardiovascular Disease

Elevated levels of protein biomarkers were associated with undetected and symptomless cardiovascular (CV) disease (CVD) in one-third of adults with type 2 diabetes (T2D) compared to those without, according to research published in the Journal of the American Heart Association. Screening for cardiac biomarkers could be added to routine assessment evaluating cardiovascular (CV) risk factors to create preventative strategies, according to the study authors.

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“What we are seeing is that many people with type 2 diabetes who have not had a heart attack, or a history of CVD are at high risk for CV complications,” said study co-author Elizabeth Selvin, PhD, MPh, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, in the press release. “These cardiac biomarkers give us a window into CV risk in people who otherwise might not be recognized as highest risk.”

In 2020, the AHA estimated that 102,188 deaths were attributed to diabetes. T2D is linked to traditional risk factors of cardiac health, including high blood pressure (BP) and cholesterol. However, cholesterol and high BP are not the only factors that influence heart health in patients with T2D, Selvin explained. In these instances, “cholesterol-lowering medications are not going to prevent cardiac damage,” she said.

Investigators believe that other biomarkers could identify risk of CVD, including troponin T and N-terminal pro-B-type natriuretic peptide. These are cardiac protein biomarkers that measure injury and stress to the heart and help diagnose heart attack and heart failure. But when these blood proteins levels are only slightly elevated, they could also serve as early warning signs of risk of future heart failure, coronary heart disease, or death.

In the current study, investigators looked at 10,300 blood samples of adults with and without T2D that were collected from the US National Health and Nutrition Examination Survey (1999 to 2004). They studied the association between the 2 protein biomarkers and risk of CV death or all-cause mortality and used them to identify previously unrecognized and symptomless CVD.

The results showed that adults with T2D had more than double the occurrence of undetected CVD compared to those without diabetes (33.4% and 16.1%). Adjusting for other CV risk factors, adults with T2D also had higher troponin and Nterminal pro-B-type natriuretic peptide levels in the blood, which are associated with a 77% and 78% increased risk of all-cause death, respectively.

The team also observed that T2D was associated with elevated levels of troponin, despite age, sex, race/ethnicity, and weight. N-terminal pro-B-type natriuretic peptide levels were not higher in people with T2D and adjusting for age. Although the study found an association between the protein biomarkers and risk of CVD, it did not identify heart disease, heart failure, stroke event, or CV complication as biomarkers of CV complications, therefore more research is needed.

“Measuring biomarkers more routinely may help us focus on CV prevention therapies for people with type 2 diabetes who are at higher risk,” Selvin said in the press release.

Reference

American Heart Association. 1 in 3 adults with Type 2 diabetes may have undetected cardiovascular disease. News Release. May 31, 2023. Accessed on May 31, 2023. https://www.eurekalert.org/news-releases/990479